Medicare Compliance Review of Southcoast Hospitals Group for Calendar Years 2010 and 2011.

摘要

Southcoast Hospitals Group (Southcoast) is a hospital system that includes three acute care hospitals: Charlton Memorial Hospital, located in Fall River, Massachusetts; St. Lukes Hospital, located in New Bedford, Massachusetts; and Tobey Hospital, located in Wareham, Massachusetts. Medicare paid Southcoast approximately $403 million for 38,056 inpatient and 405,847 outpatient claims for services provided to beneficiaries during calendar years (CY) 2010 and 2011 based on CMSs National Claims History data. Our audit covered $2,801,148 in Medicare payments to Southcoast for 338 claims that we judgmentally selected as potentially at risk for billing errors. These claims had dates of service in CYs 2010 and 2011 and consisted of 217 inpatient and 121 outpatient claims. Our objective was to determine whether Southcoast complied with Medicare requirements for billing inpatient and outpatient services on selected claims.